metacognitive training
{{Short description|Treatment for psychosis in schizophrenia}}
{{About
| a treatment for psychosis in schizophrenia
| the psychotherapy focused on modifying metacognitive beliefs that perpetuate negative thinking
| Metacognitive therapy
}}
Metacognitive training (MCT) is an approach for treating the symptoms of psychosis in schizophrenia,{{Cite book|title=Metacognition Study Group: Metacognitive Training for schizophrenic patients (MKT). Manual.|last1=Moritz|first1=S.|last2=Bohn|first2=F.|last3=Veckenstedt|first3=R.|last4=Hottenrott|first4=B.|last5=Woodward|first5=T.|publisher=VanHam Campus Publishing House|year=2016|location=Hamburg}} especially delusions,{{Cite journal|last1=Moritz|first1=Steffen|last2=Andreou|first2=Christina|last3=Schneider|first3=Brooke C.|last4=Wittekind|first4=Charlotte E.|last5=Menon|first5=Mahesh|last6=Balzan|first6=Ryan P.|last7=Woodward|first7=Todd S.|date=June 2014|title=Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia|journal=Clinical Psychology Review|volume=34|issue=4|pages=358–366|doi=10.1016/j.cpr.2014.04.004|issn=0272-7358|pmid=24866025|doi-access=free|hdl=2440/96875|hdl-access=free}} which has been adapted for other disorders such as depression, obsessive–compulsive disorder and borderline over the years (see below). It was developed by Steffen Moritz and Todd Woodward. The intervention is based on the theoretical principles of cognitive behavioral therapy, but focuses in particular on problematic thinking styles (cognitive biases) that are associated with the development and maintenance of positive symptoms, e.g. overconfidence in errors and jumping to conclusions.{{Cite journal|last1=Garety|first1=P. A.|last2=Freeman|first2=D.|date=November 2013|title=The past and future of delusions research: from the inexplicable to the treatable|journal=The British Journal of Psychiatry|language=en|volume=203|issue=5|pages=327–333|doi=10.1192/bjp.bp.113.126953|pmid=24187067|issn=0007-1250|doi-access=free}} Metacognitive training exists as a group training (MCT) and as an individualized intervention (MCT+).{{Cite book|last1=Moritz|first1=Steffen|last2=Krieger|first2=Eva|last3=Bohn|first3=Francesca|last4=Veckenstedt|first4=Ruth|date=2017|title=MKT+|language=en-gb|doi=10.1007/978-3-662-52998-0|isbn=978-3-662-52997-3}}
Background
Metacognition can be defined as "thinking about thinking".{{Cite journal|last=Flavell|first=John H.|date=1979|title=Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry.|journal=American Psychologist|language=en|volume=34|issue=10|pages=906–911|doi=10.1037/0003-066x.34.10.906|issn=0003-066X}} Over the course of the training, cognitive biases subserving positive symptoms are identified and corrected. The current empirical evidence assumes a connection between certain cognitive biases, such as jumping to conclusions, and the development and maintenance of psychosis. Accordingly, correcting these problematic/unhelpful thinking styles should lead to a reduction of symptoms.
Intervention
In eight training units (modules) and two additional modules, examples of "cognitive traps", which can promote the development and maintenance of the positive symptoms of schizophrenia, are presented to patients in a playful way. Patients are instructed to critically reflect on their thought patterns, which may contribute to problematic behaviors, and to implement the contents of the training in everyday life. MCT deals with the following problematic styles of thinking: monocausal attributions, jumping to conclusions, inflexibility, problems in social cognition, overconfidence for memory errors and depressive thought patterns. The additional modules deal with stigma and low self-esteem. Individualized metacognitive training (MCT+) targets the same symptoms and cognitive biases as the group training, but is more flexible in that it allows discussion of individualized topics. The treatment materials for the group training can be obtained free of charge in over 30 languages from the website.{{Cite journal|last1=Moritz|first1=Steffen|last2=Veckenstedt|first2=Ruth|last3=Andreou|first3=Christina|last4=Bohn|first4=Francesca|last5=Hottenrott|first5=Birgit|last6=Leighton|first6=Lucy|last7=Köther|first7=Ulf|last8=Woodward|first8=Todd S.|last9=Treszl|first9=András|date=2014-10-01|title=Sustained and "Sleeper" Effects of Group Metacognitive Training for Schizophrenia|journal=JAMA Psychiatry|language=en|volume=71|issue=10|pages=1103–11|doi=10.1001/jamapsychiatry.2014.1038|pmid=25103718|issn=2168-622X|doi-access=free}}
Efficacy
A recent meta-analysis found significant improvements for positive symptoms and delusions, as well as the acceptance of the training.{{Cite journal|last1=Eichner|first1=Carolin|last2=Berna|first2=Fabrice|date=2016-07-01|title=Acceptance and Efficacy of Metacognitive Training (MCT) on Positive Symptoms and Delusions in Patients With Schizophrenia: A Meta-analysis Taking Into Account Important Moderators |journal=Schizophrenia Bulletin|language=en|volume=42|issue=4|pages=952–962|doi=10.1093/schbul/sbv225 |pmc=4903058|pmid=26748396}} These findings have been replicated in 2018{{Cite journal|last1=Liu|first1=Yu-Chen|last2=Tang|first2=Chia-Chun|last3=Hung|first3=Tsai-Tzu|last4=Tsai|first4=Pei-Ching|last5=Lin|first5=Mei-Feng|date=2018-02-28|title=The Efficacy of Metacognitive Training for Delusions in Patients With Schizophrenia: A Meta-Analysis of Randomized Controlled Trials Informs Evidence-Based Practice|journal=Worldviews on Evidence-Based Nursing|language=en|volume=15|issue=2|pages=130–139|doi=10.1111/wvn.12282|pmid=29489070|issn=1545-102X|doi-access=free}} and 2019.{{Cite journal|last1=Philipp|first1=Rebecca|last2=Kriston|first2=Levente|last3=Lanio|first3=Jana|last4=Kühne|first4=Franziska|last5=Härter|first5=Martin|last6=Moritz|first6=Steffen|last7=Meister|first7=Ramona|date=2019|title=Effectiveness of metacognitive interventions for mental disorders in adults—A systematic review and meta-analysis (METACOG)|journal=Clinical Psychology & Psychotherapy|language=en|volume=26|issue=2|pages=227–240|doi=10.1002/cpp.2345|pmid=30456821|issn=1063-3995}} An older meta-analysis based on a smaller number of studies found a small effect,{{Cite journal|last1=Oosterhout|first1=B. van|last2=Smit|first2=F.|last3=Krabbendam|first3=L.|last4=Castelein|first4=S.|last5=Staring|first5=A. B. P.|last6=Gaag|first6=M. van der|date=January 2016|title=Metacognitive training for schizophrenia spectrum patients: a meta-analysis on outcome studies|journal=Psychological Medicine|language=en|volume=46|issue=1|pages=47–57|doi=10.1017/S0033291715001105|pmid=26190517|s2cid=25707116|issn=0033-2917}} which reached significance when newer studies were considered.{{Cite journal|last1=Oosterhout|first1=B. van|last2=Smit|first2=F.|last3=Krabbendam|first3=L.|last4=Castelein|first4=S.|last5=Staring|first5=A. B. P.|last6=Gaag|first6=M. van der|date=July 2016|title=Letter to the Editor: Should we focus on quality or quantity in meta-analyses?|journal=Psychological Medicine|language=en|volume=46|issue=9|pages=2003–2005|doi=10.1017/S003329171600009X|pmid=26888290|issn=0033-2917|doi-access=free}} Individual studies provide evidence for the long-term effectiveness of the approach beyond the immediate treatment period.{{Cite journal|last1=Favrod|first1=J.|last2=Rexhaj|first2=S.|last3=Bardy|first3=S.|last4=Ferrari|first4=P.|last5=Hayoz|first5=C.|last6=Moritz|first6=S.|last7=Conus|first7=P.|last8=Bonsack|first8=C.|date=June 2014|title=Sustained antipsychotic effect of metacognitive training in psychosis: A randomized-controlled study|journal=European Psychiatry|volume=29|issue=5|pages=275–281|doi=10.1016/j.eurpsy.2013.08.003|pmid=24176646|issn=0924-9338}} A meta-analysis{{Cite journal |last1=Penney |first1=Danielle |last2=Sauvé |first2=Geneviève |last3=Mendelson |first3=Daniel |last4=Thibaudeau |first4=Élisabeth |last5=Moritz |first5=Steffen |last6=Lepage |first6=Martin |date=2022-05-01 |title=Immediate and Sustained Outcomes and Moderators Associated With Metacognitive Training for Psychosis: A Systematic Review and Meta-analysis |url=https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2790555 |journal=JAMA Psychiatry |language=en |volume=79 |issue=5 |pages=417–429 |doi=10.1001/jamapsychiatry.2022.0277 |issn=2168-622X |pmc=8943641 |pmid=35320347}} based on 43 studies (N = 1,816 individuals) showed that MCT improved delusions, hallucinations, cognitive biases, negative symptoms and functioning. MCT is recommended as an evidence-based treatment by the Royal Australian and New Zealand College of Psychiatrists{{Cite journal|last1=Galletly|first1=C.|last2=Castle|first2=D.|last3=Dark|first3=F.|last4=Humberstone|first4=V.|last5=Jablensky|first5=A.|last6=Killackey|first6=E.|last7=Kulkarni|first7=J.|last8=McGorry|first8=P.|last9=Nielssen|first9=O.|date=April 22, 2016|title=Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.|journal=Australian and New Zealand Journal of Psychiatry|volume=50|issue=5|pages=410–472|doi=10.1177/0004867416641195|pmid=27106681|last10=Tran|first10=N.|doi-access=free}} as well as the German Association for Psychiatry, Psychotherapy and Psychosomatics.{{Cite book|title=S3-Leitlinie Schizophrenie [S3 guideline schizophrenia]|last=Gaebel|first=Wolfgang|publisher=Springer|year=2019|isbn=978-3-662-59380-6|location=Berlin}}
Adaptations to other disorders
Since its introduction, MCT has been adapted to other mental disorders. Empirical studies have been carried out for borderline personality disorder,{{Cite journal|last1=Schilling|first1=Lisa|last2=Moritz|first2=Steffen|last3=Kriston|first3=Levente|last4=Krieger|first4=Maria|last5=Nagel|first5=Matthias|date=2018|title=Efficacy of metacognitive training for patients with borderline personality disorder: Preliminary results|journal=Psychiatry Research|language=en|volume=262|pages=459–464|doi=10.1016/j.psychres.2017.09.024|pmid=28927866}} obsessive–compulsive disorder (self-help approach), depression,{{Cite journal|last1=Jelinek|first1=Lena|last2=Faissner|first2=Mirjam|last3=Moritz|first3=Steffen|last4=Kriston|first4=Levente|date=2018-12-16|title=Long-term efficacy of Metacognitive Training for Depression (D- MCT ): A randomized controlled trial|journal=British Journal of Clinical Psychology|volume=58|issue=3|language=en|pages=245–259|doi=10.1111/bjc.12213|pmid=30556583|issn=0144-6657}} bipolar disorders,{{Cite journal|last1=Haffner|first1=Paula|last2=Quinlivan|first2=Esther|last3=Fiebig|first3=Jana|last4=Sondergeld|first4=Lene-Marie|last5=Strasser|first5=Elisa Sophie|last6=Adli|first6=Mazda|last7=Moritz|first7=Steffen|last8=Stamm|first8=Thomas Josef|date=2018|title=Improving functional outcome in bipolar disorder: A pilot study on metacognitive training|journal=Clinical Psychology & Psychotherapy|language=en|volume=25|issue=1|pages=50–58|doi=10.1002/cpp.2124|pmid=28857347|doi-access=free}} and problem gambling.{{Cite journal|last1=Gehlenborg|first1=Josefine|last2=Bücker|first2=Lara|last3=Berthold|first3=Mira|last4=Miegel|first4=Franziska|last5=Moritz|first5=Steffen|date=2020-09-21|title=Feasibility, Acceptance, and Safety of Metacognitive Training for Problem and Pathological Gamblers (Gambling-MCT): A Pilot Study|journal=Journal of Gambling Studies|volume=37|issue=2|pages=663–687|language=en|doi=10.1007/s10899-020-09975-w|pmc=8144133|pmid=32955694|issn=1573-3602|doi-access=free}} MCT has also been modified to target the difficult-to-treat negative symptoms in schizophrenia, a recent feasibility study found good feasibility and improved negative symptoms.{{Cite journal |last=Swanson |first=Linda |last2=Schwannauer |first2=Matthias |last3=Bird |first3=Tim |last4=Eliasson |first4=Emma |last5=Millar |first5=Audrey |last6=Moritz |first6=Steffen |last7=Griffiths |first7=Helen |date=2022 |title=Metacognitive training modified for negative symptoms: A feasibility study |url=https://onlinelibrary.wiley.com/doi/10.1002/cpp.2692 |journal=Clinical Psychology & Psychotherapy |language=en |volume=29 |issue=3 |pages=1068–1079 |doi=10.1002/cpp.2692 |issn=1099-0879}}
References
External links
- [https://clinical-neuropsychology.de/metacognitive_training-psychosis/ Metacognitive Training for Psychosis] Link to training material and manual.
- [https://clinical-neuropsychology.de/metacognitive-therapy-plus-individualized-mct-for-psychosis/ Metacognitive Training for Psychosis, Individualized (MCT+)] Link to training material and manual.
- [https://clinical-neuropsychology.de/metacognitive-training-for-ocd-mymct/ Metacognitive Training for Obsessive-Compulsive Disorder (myMCT)] Link to training material and self-help manual.
- [https://clinical-neuropsychology.de/metacognitive_training_for_depression/ Metacognitive Training for Depression] Link to training material and manual.
- [https://clinical-neuropsychology.de/metacognitive-training-for-borderline-personality-disorder/ Metacognitive Training for Borderline Personality Disorder] Link to training material and manual.
{{Cognitive behavioral therapy}}
{{Psychotherapy}}
Category:Psychotherapy by type